Web-based training and supervision for LGBT-affirmative mental health practice: A randomized controlled trial

Abstract

Abstract Background Lesbian, gay, bisexual, and transgender (LGBT) individuals in most countries remain stigmatized, requiring culturally sensitive mental health care to foster coping and resilience. This trial tested the efficacy of an LGBT-affirmative mental health training for psychologists and psychiatrists in Romania, where such resources are scarce. The trial compared in-person and web-based training modalities. Methods Participants were randomized to a 2-day training either in-person (n = 56) or via web by viewing the live-streamed training (n = 54), and assessed pre- and 5-, 10- and 15-months post-training, with optional monthly web-based supervision (n = 47) after the first follow-up. Generalized linear mixed models were conducted to assess for change across time. Results The sample (M age=34.98) was mostly female (88%) and heterosexual (84%). Trainees, regardless of in-person or web-based attendance, reported significant decreases from baseline to 15-month follow-up in explicitly (b = 0.21, 95% CI 0.06 − 0.37, p < 0.01) and implicitly (b = 0.26, 95% CI 0.10 − 0.41, p < 0.001) assessed homonegativity, and significant increases in LGBT-affirmative clinical skills (b = -1.19, 95% CI -1.41− -1.00, p < 0.001), beliefs (b = -0.17, 95% CI -0.31 − -0.03, p < 0.05) and behavior (b = -1.17, 95% CI -1.72 − -0.61, p < 0.05). Conclusions Training in LGBT-affirmative mental health can change provider attitudes and practice in high-stigma countries. The fact that web-based trainings were equally efficacious as in-person trainings suggests that such education can have widespread reach. As LGBT individuals represent one of the highest-risk global populations for mental health problems driven by stigma, findings hold strong public health potential. Future research should assess the impact of such trainings across high-need settings and include patient outcomes.